Temporal trends in cardiovascular complications in people with or without type 2 diabetes: The Fremantle Diabetes Study.

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There is evidence that diabetes-related complications are declining but most data sources have limitations.To characterize temporal changes in incidence rates (IRs) of chronic complications and mortality in well characterized, community-based Australians.Longitudinal observational study.Urban population.Participants with type 2 diabetes from the Fremantle Diabetes Study Phases I (FDS1; n=1291 recruited 1993-1996) and II (FDS2; n=1509 recruited 2008-2011) age-, sex- and zip code-matched 1:4 to people without diabetes.First hospitalizations for/with myocardial infarction (MI), stroke, heart failure (HF), lower extremity amputation (LEA), and cardiovascular disease (CVD) and all-cause mortality. Five-year IRs, IR ratios (IRRs) for those with versus without diabetes in FDS1 and FDS2, and IR differences (IRDs), were calculated.The 13,995 participants had a mean age of 64.8 years and 50.4% were males. There were lower IRRs for MI, stroke, HF and CVD death in FDS2 versus FDS1. IRDs for people with versus without type 2 diabetes had reduced by >50% between phases for MI, stroke, HF, LEA and CVD death, with no change in IRD for all-cause mortality. Within the pooled type 2 diabetes cohort, FDS2 versus FDS1 participation was an independent inverse predictor of stroke, HF, CVD death and all-cause mortality after adjustment in Cox proportional hazards models.Cardiovascular outcomes in Australians have improved since the 1990s, especially in type 2 diabetes. The difference in all-cause mortality between those with and without type 2 diabetes has persisted despite longer survival.


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